A total of 274 parturients were surveyed. More than half (58%) were met at the Buea Regional Hospital (BRH), while 115(42%) were met at Limbe Regional Hospital (LRH). Amongst them, 158(57%) were surveyed at the maternity unit, 94(34.3%) at the vaccination unit, and 22(8%) at the neonatology unit. Out of the 274 participants, a majority, 127 (46.4%) were met in their first 2days postpartum. The minimum duration from delivery was from the day of delivery to a maximum of 56days postpartum (range = 56days, mean = 9.81days, SD = 14.06).
Parturients socio-demographic characteristics
The parturients were aged from 15 to 42 years (range = 27), most of whom were between 25–29 years (31.8%). The mean maternal age was 26.69years (SD = 5.34). A majority the of respondents (36.9%) were non-civil servants, married (39.1%) and Christians (97.4%). More than two-thirds (71.5%) of the respondent’s delivered vaginally, while 78 (28.5%) delivered by emergency cesarean section.
Table 1: Parturients socio-demographic characteristics
|
Socio-demographic characteristics
|
Number of participants
|
Percentage (%)
|
|
Age of baby
|
0-2days
|
127
|
46.4
|
2days -2weeks
|
96
|
35.0
|
2-6weeks
|
46
|
16.8
|
6-8weeks
|
5
|
1.8
|
|
Maternal Age(years)
|
<20
|
17
|
6.2
|
20-24
|
83
|
30.3
|
25-29
|
87
|
31.8
|
30-34
|
69
|
25.2
|
≥35
|
18
|
6.6
|
|
Occupation
|
Civil servants
|
64
|
23.4
|
Housewife
|
38
|
13.9
|
Student
|
71
|
25.9
|
Applicant/non civil servants
|
101
|
36.9
|
|
Religion
|
Christian
|
267
|
97.4
|
Muslim
|
6
|
2.2
|
|
Marital status
|
Married
|
107
|
39.1
|
Single
|
66
|
24.1
|
cohabiting
|
101
|
36.9
|
|
Number of children alive (including most recent)
|
1
|
129
|
47.1
|
2
|
65
|
23.7
|
≥3
|
80
|
29.2
|
|
Mode of delivery of recent delivery
|
Vaginal
|
196
|
71.5
|
Emergency c/s
|
78
|
28.5
|
Physical and verbal mistreatments
A total of 69(25.18%) of the 274 parturients reported to have experienced at least a physical and or verbal mistreatment during labour and delivery. forty-one (15%) reported at least a verbal abuse while 28(11%) reported at least a physical abuse. The most reported verbal abuse was scolding (6.2%) followed by threats to have a bad pregnancy outcome (2.9%) and then threats to withhold care (2.9%). The most reported physical abuse was downward pressure on the abdomen (4.4%) followed by pinching on the thigh (2.6%) (Table 2).
Table 2
Verbal and physical abuse reported by respondents
Mistreatment
|
Count (from the 274 parturients)
|
Percentage (%)
|
Scolding
|
17
|
6.2
|
Down pressure on the abdomen
|
12
|
4.4
|
Threatened with bad outcome
|
8
|
2.9
|
Threatened to withhold care
|
8
|
2.9
|
Pinched
|
7
|
2.6
|
Blamed for poor outcome
|
7
|
2.6
|
Held down forcefully
|
4
|
1.5
|
Threatened with procedure
|
4
|
1.5
|
Slapped on the thigh
|
3
|
1.1
|
Insulted
|
3
|
1.1
|
Mocked
|
2
|
0.7
|
Other verbal abuses
|
2
|
0.7
|
Physically tied on the delivery bed
|
1
|
0.4
|
Negative comment on medical status
|
1
|
0.4
|
Amongst the parturients who reported verbal abuse, 78.04% of them reported a single type of abuse, while 19.51% and 2.4% reported two and 3 or more different types of verbal abuses respectively. Amongst those who reported physical abuse, 23(82.14%), 4(14.29%) and 1(3.57%) reported a single type, two types and 3 or more different types of physical abuse respectively. About 23% of the 69 cases reported to have experienced the two types of mistreatments (verbal and physical) during labour and delivery. More than half, 41(59.4%) of the respondents who reported to have experienced a physical or verbal abuse reported to have experienced a particular type of abuse more than once, while 6 (8.7%) could not remember the number of times they experienced a given mistreatment. Also, 61(88.40%) of the 69 parturients reported to have experienced this mistreatment before delivery, while 10 (14.49%) experienced it after delivery. About 4% experienced mistreatment both before and after delivery while 5.8% of them could not remember when they experienced the abuse. In 95.65% of the cases, the mistreatment was reported to have been done by the midwife or nurse while in 10.14% of the cases by the Doctor (general practitioner, obstetrician). The trainees and non-staffs were incriminated in 7.24% and 1.45% of the cases respectively.
Vaginal examinations
Out of the 274 respondents sampled 272 (99.3%) parturients received vaginal examination. Seventy-five respondents (27.57%) reported that vaginal examinations were not private while 70.96% of respondents reported that privacy conditions were respected during the process.
About one-fifth (20.59%) of the 272 parturients reported that the vaginal examinations were not comfortable, with 4 to 5% reporting that it was very uncomfortable.
Pain relief
Of the 274 parturients, 248(90.5%) received one or more forms of pain relief. Only 41 (15%) requested pain relief, while 12 (4.4%) were refused pain relief.
Birth companion
Out of 274 parturients 149 (54.4%) of them were allowed to have a birth companion before or during childbirth. Amongst the 149, 52(35.86%) of them had companion from labour till after childbirth, 50(34.48%) had during labour only, 3(2%) had a companion from childbirth till after delivery. Only 1–2% had a birth companion during childbirth only. Of the 149 parturients who had birth companions, Close to 50% had a personnel while about 40% had a family member as companion during labour and delivery respectively. Husbands and friends were companions in 10.47% and 3.36% of the cases respectively.
Unreasonable demands
Of the 274 respondents 5 (1.8%) of the participants reported to have been asked to clean the examination/delivery bed, while 11(4.0%) reported to have been asked informal payments.
Supportive care
Thirty-three (12.04%) of the 274 participants perceived to have been ignored (with up to 36.4% of the 33 agreeing strongly to have been ignored). Also, 15.69% of the 274 parturients felt neglected (25.58% amongst them feeling strongly neglected) while 5.87% felt as if they were a nuisance to the personnel. About 6% of the participants felt to have waited for long periods of time before being attended to by the personnel when they arrived the health facility (BRH, LRH), while 8.76% of the 274 participants felt that their questions and concerns were not listened to and/or addressed. However, a majority, 242 (88.3%) of the 274 respondents felt that they were supported emotionally by the personnel. Only 4.38% felt strongly that they were not supported emotionally.
Childbirth
During childbirth, the personnel was always present for 40.1% of the times, 51.1% most of the time and 8.8% sometimes. The personnel most present during labour and childbirth were midwives and nurses. The midwives were present in 46.7% and the nurses in 23.0%. The other personnel who attended to the delivery, medical students (10.2%), midwifery/nursing students (5.8%) and doctors (3.3%). Only 2 (0.7%) of the 274 respondents reported that no personnel was present when the baby came out. Also, 193 (70.4%) reported that there were measures of confidentiality in the labour room. On the other hand, 69 (25.2%) reported that no measures for confidentiality were used in the labour room during their own time (free movements of persons into and out of labour room, lack of shields, parturients health information easily heard by others and sometimes care-givers present).
Detainment in the hospital for inability to pay medical bills
Four (1.5%) of the 274 respondents reported to have been detained or had their discharged period prolonged due to their inability to pay their hospital bills.
Autonomy and informed consent
Of the 274 participants, 75 (27.4%) had a cesarean section, 180 (65.5%) had uterine revision, 12 (4.4%) had an induction of labour and 65(23.7%) had augmentation of labour. On the average, the procedure was explained to 75.11% of the parturients amongst whom 71.52% consented.
Perception of care given
Up to 45.99% perceived that education given was not enough to meet their needs from labour till after birth, with 4.4% perceiving that it was absent. More than two thirds of respondents (82.12%) felt that there was enough privacy in the labour, given the nature of restrictions of entry and exit of persons while about 12.8% perceived that the level of privacy was inadequate (as a patient and sometimes care-givers could see the next labouring parturients’ nakedness during examination) with 4.0% of participants perceiving that there was no privacy at all. Closed to 5% of the participants were neutral. Of the 274 participants, only 6 (2.2%) of the participants felt that their religious needs were not respected, while 158 (37.7%) felt that it was respected for their situation. The majority of participants (39.2%) were neutral (as they did not exercise any religious duty). Most of the 274 participants, 260 (94.9%), felt to have been treated with respect, while (7) 2.6% felt to have been treated with no respect. Seven (7) of the participants were equally neutral in their perception of being treated with respect or not. Forty-one (15%), of the participants felt that they were not informed about decisions taken on them concerning their care, meanwhile 16 (5.8%) were neutral. More than a third of respondents, 101(36.9%), felt that they did not make shared decisions during their care, and 32 (11.7%) were neutral (maybe because they trusted the personnel or were not even given the chance or were not aware of their rights). (Tables 3 and 4).
Table 3
Perceived respectful Categories of care reported
Care category
|
Percentage (%)
|
Treatment with respect
|
94.9
|
Cultural and religious respected
|
57.7
|
Had a good relationship and communication with the personnel
|
91.6
|
Was treated in a timely, safely and careful manner by the personnel
|
86.9
|
Informed about decisions concerning their care
|
79.2
|
Were emotionally supported
|
88.3
|
Table 4
Perceived disrespectful care categories reported
Care categories
|
Percentage (%)
|
Not encouraged to hold and breastfeed baby
|
39.7
|
Health education offered did not meet their needs
|
45.99
|
Privacy of parturients not respected
|
12.8
|
Was passively involved in decision making
|
36.9
|
Waited for long periods of time before being attended to by personnel on admission
|
13.87
|
Overall satisfaction
Of the 274 participants, 235 (85.77%) felt satisfied with the overall care given to them from arrival till delivery. Seventeen (6.2%) were neutral while 20 (7.30%) were not satisfied. Seven (2.6%) were very unsatisfied with the care given to them by the personnel. (Fig. 1).
Respectful care categories perceived
Out of 274 participants, 251 (91.61%) agreed that they had a good relationship, interaction and or communication with the personnel, with 66.8% participants feeling that they had a very good relationship. On the other hand, 5.8% of the participants felt that they did not have a good interaction, with 1–2% feeling that they had a very poor interaction with the personnel taking care of them during labour and delivery. Also, 238 (86.9%) felt that they were treated safely, carefully and in a timely manner, meanwhile, 30 (10.9%) of the participants felt that they weren’t treated safely, carefully and in a timely manner. 6 (2.2%) of the participants were neutral. In 254 (92.7%) of the respondents, participants felt that the personnel were actively participating in their labour process. On the contrary, 5.8% of participants did not feel this way, while 4 (1.5%) of the participants were neutral to this point. Of the 274 participants sampled, 145 (52.9%) were adequately encouraged to hold and breastfeed their babies as soon as possible after vaginal delivery, or emergency cesarean section. Up to 109 (39.7%) felt that they were not adequately encouraged to do so, with 19.3% reporting that, the personnel did not encourage them at all after they had delivered. Meanwhile, 20 (7.3%) were neutral to that point. More than four-fifths, 242 (88.3%) of the participants felt emotionally supported during labour and delivery against only 4.38% who strongly disagreed to being strongly emotionally supported.
Table 5
The five (5) main disrespectful care categories reported
Categories of mistreatment identified
|
Percentage (%)
|
Physical abuse
|
10.22
|
Verbal abuse
|
14.96
|
Failure to meet professional demands
|
Absence of measures for confidentiality
|
25.20
|
Uncomfortable vaginal examination
|
20.60
|
Refusal of pain relief
|
4.40
|
Lack of informed consent before procedure
|
24.89
|
Neglect and ignoring of parturients
|
27.74
|
Lack of encouragement of mother baby relationship
|
39.7
|
Poor rapport between provider and parturients
|
Dismissal of the women’s concerns
|
8.80
|
Lack of supportive care (no emotional support/lack of birth companion)
|
49.98
|
Loss of autonomy/passive involvement of women in the management (no shared decision making)
|
36.90
|
Health system conditions and constraints
|
Lack of curtains and shields to provide privacy
|
27.57
|
Unreasonable demands (asking parturients to clean examination bed/asking of gift or money informally or illegally)
|
5.80
|
Determinants of mistreatments during labour and delivery.
To obtain the determinants of mistreatments during labour and delivery, the dependent variables (disrespectful care categories reported) were aggregated into dichotomous variables (yes, no) and bivariate logistic regression was computed at 95% confidence interval against the independent variables (socio-demographic factors). Only religion was significantly associated with a verbal mistreatment after bivariate logistic regression analysis. There was no significant factor associated with any physical or other verbal mistreatments. Muslim parturients were significantly more likely to be insulted compared to Christian parturients (OR 26.50, 95%CI: 2.05-342.22, P = 0.001).
Table 6: Determinants of mistreatments during labor and delivery (Bivariate logistic regression)
Care category
|
Determinants
|
Subcategories
|
OR (95%CI)
|
|
P-value
|
Insult
|
Religion
|
Muslim
|
26.50 (2.05-342.22)
|
|
0.001
|
Privacy during vaginal exams
|
Marital status
|
Cohabiting
|
3.06 (1.49–6.26)
|
|
0.025
|
Overall satisfaction
|
Number of pregnancies beyond 7months
|
Two (2)
|
5.35 (1.211–23.60)
|
|
0.035
|
|
Location/residence
|
In town of residence
|
0.27 (0.91 − 0.80)
|
|
0.02
|
|
Number of children alive
|
1 child alive
|
1.80 (1.14–2.85)
|
|
0.032
|
C. section explained
|
Health Facility
|
Limbe regional hospital
|
0.88 (0.04–0.91)
|
|
0.016
|
Offered emotional support
|
Religion
|
Christian
|
0.22 (0.05–0.90)
|
|
0.009
|
Informed decision making
|
Health Facility
|
Buea Regional hospital
|
2.64 (1.31–5.35)
|
|
0.025
|
OR: odd ratio, CI: confident interval